Organization
PHOENIX HOUSES OF LOS ANGELES
Active
Organization
PHOENIX HOUSES OF LOS ANGELES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH SALAZAR MPH (REGIONAL CLINICAL DIRECTOR)
(818) 686-3015
Entity
Organization
Contact information
Practice address
11465 KAGEL CANYON ST, LAKE VIEW TERRACE, CA 91342-6505
(818) 686-3000
Mailing address
11600 ELDRIDGE AVE, LAKE VIEW TERRACE, CA 91342-6506
(818) 686-3000
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
190115DN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1945
MEDICAL
CA
Enumeration date
06/25/2013
Last updated
12/02/2013
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